1. Introduction

The aim of this review is to provide an overview of the best available evidence in relation to ‘what works’ in increasing the percentage of people aged 65 and over with high level care needs who are cared for at home. This is the aim of one of the Scottish Government’s 45 indicators of success in achieving national outcomes identified in the National Performance Framework. Government policy changes rapidly and in the current financial climate it has never been more important to ensure that such changes are informed by good quality research evidence. Determining ‘what works’ is complex and is often contested. How it is determined depends on which particular outcome one is attempting to measure. This review attempts to highlight ‘what works’ from the perspectives of all the key stakeholders involved in the process. It will also highlight where there is a lack of high quality research evidence.

Terminology There were significant challenges in defining higher level needs. In 2010 the Scottish Government indicated that homecare inputs of over ten hours each week were regarded as intensive packages. Other measures would suggest that receiving more than 20 hours of homecare each week indicates higher level needs. For the purposes of the review only studies that defined their sample group as having ‘higher level, complex or intensive needs’ or those with dementia were included. In addition sample groups of people over 65 who received interventions from both health and social care were included.